Role of Other Drugs (non dopamine agonists) in Migraine Management
Here the word “other drugs” means, other than commonly used 5-HT1 agonists, common and simple analgesics (pain relievers), NSAIDs, dopamine antagonists etc. The roles of the other drugs are also very important in management of migraine headache, especially if migraine is not controlled by the commonly used drugs.
Oral preparations:
The oral combination of paracetamol (acetaminophen), dichloralphenazone, and isometheptene is classified by USFDA as “possibly” effective in the treatment of migraine. The combination is taken as one to two capsules a day. The comparison of this combination with commonly used triptans is difficult as there is no clinical trial on the subject.
Nasal preparations:
Butorphanol is available as nasal spray for the treatment of acute migraine headache. Butorphanol is a narcotic drug and the use of it should be limited to a select group of migraineurs.
Parenteral preparations:
The use of narcotics in the acute treatment of migraine headache can be very effective. Intravenous meperidine at the dose of 50 to 100 mg is given frequently in the emergency room, which is a narcotic drug. The use of intravenous meperidine can work in the sense that the pain of migraine headache is eliminated, but this regimen is clearly suboptimal for patients with recurrent migraine headache. Narcotics can not treat the cause of migraine, but acts as symptomatic relief as they can alter the pain sensation. Moreover, the addiction liability of narcotics are known to all and in patients taking oral narcotics such as oxycodone or hydrocodone, narcotic addiction can greatly confuse the treatment of migraine. Narcotic craving and/or withdrawal can aggravate and accentuate migraine headache which may be a bigger problem than the migraine itself. So the patients for treating with narcotics should be selected very carefully to prevent the side effects of narcotics. The ideal candidate for treatment with narcotics is a patient with severe but infrequent migraine headache. Patients with chronic and frequent migraine should never be given narcotics for migraine treatment.